Ewing's sarcoma of the pelvis: combined surgery and radiotherapy treatment.

Abstract

Local therapy of pelvic Ewing's sarcoma remains a challenge because of the complex anatomy and large tumor volumes. Wide resections often end up contaminated with marginal margins in one part of the specimen. Pelvic tumor surgery causes considerable disability, because of the loss of hip function. This may cause a low quality of life for tumor survivors. The aim of the study was to evaluate the oncologic results of combined surgery and radiotherapy of pelvic Ewing's sarcoma. Functional and psychosocial outcome of the tumor survivors was assessed. Thirty-six pelvic Ewing's sarcoma patients were treated surgically for local tumor control between 1986 and 1996. Chemotherapy was administered according to current European Intergroup/Cooperative Ewing's Sarcoma Study (EI/CESS) protocols. Radiotherapy was also performed on all patients. All patients were intended to get wide tumor excision and a limb salvage procedure. Complications necessitating operative revision were analyzed and functional results were scored according to the criteria of the Musculoskeletal Tumor Society (MSTS). Quality of life and psychosocial functioning was assessed by the QLQ-C 30 of the European Organization for Research and Treatment of Cancer (EORTC). The overall 5- and 10-year survival rate was 45%. The prognosis of patients with primary metastases was 33%. There were two local recurrences after marginal resection. Every second patient needed at least one surgical revision. A secondary hindquarter amputation was avoided in all patients. MSTS functional evaluation instruments reached 59% (+/-21.0%). Global quality of life of the QLQ-C 30 showed good results (70 +/- 16%) compared to the general population (75 +/- 24%). The advantages of surgical local control of pelvic Ewing's sarcoma should be offered to the patient. Quality of life measurement after internal hemipelvectomy shows that the life of these patients is more than worth living and that they are able to compensate the functional impairment.